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California wants to lead the way on health care

The Golden State is eager to blaze a trail after its own attempts at health reform have failed. |
Reuters
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“California has made a big investment, historically as well as recently, to get this moving,” said HHS Secretary Dooley.

The state will certainly tap that knowledge as it moves forward on confronting unique challenges that come with both the state’s size and its budgetary constraints. In interviews with POLITICO, multiple California officials said a crucial trial will be moving from a patchwork system for administering public benefits to a statewide program that can handle an expected influx of about 4 million to 5 million citizens into both public and private programs over the next decade.

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The task is daunting when you run the numbers on California’s fragmented enrollment system for Medi-Cal, the state’s Medicaid program. California’s 58 counties are currently split among three separate systems that track claims, determine eligibility and distribute benefits. Those systems are under a fourth, an umbrella system that keeps track of the entire Medi-Cal population. And there is still a fifth eligibility system that deals specifically with the State Children’s Health Insurance Program.

The federal health reform law requires a single entry point for both the exchanges and the public benefit programs, one that’s easy to navigate and delivers a high-quality retail experience, directing new enrollees to the appropriate program, whether that’s Medicaid or subsidized insurance through the exchange. Whether the three systems merge into one or meet at a single entry point will be a crucial decision for California’s implementing bodies.

“Having a system that is integrated ... is going to be critical,” said Belshe. “It’s a challenge all states are going to face; it’s just particularly complex in California, [which] has a multisystem foundation upon which either we will build or need to transition away from.”

Moreover, the state’s fiscal crisis always serves as a backdrop to efforts to implement health reform. Just last week, Gov. Jerry Brown proposed a budget that would take away $1.7 billion from Medi-Cal and institute a $5 co-pay for physician, clinic and pharmacy services. The state already has the lowest spending per enrollee in the nation.

“The [challenge] we have to be honest about is that [reform] coincides with the worst fiscal crisis in our memory, and that’s a real challenge,” said Zingale. “The risk is that if Congress in any way undermines federal support, that’s very problematic. We’re not in a position right now to go it alone.”

Belshe, Dooley and others involved in implementing health reform concede that the scope of challenges they face is daunting. But they say the state is aware of the challenges and, by keeping an aggressive pace, will be able to find workable solutions. In the face of a difficult state budget, for example, the state squirreled away its $1 million for exchange planning, reserving it exclusively for the hiring of a health exchange staff. Where other states have hesitated, waiting for new governors to be seated or federal guidance to be released, the Golden State has unfailingly pushed ahead.

“We are absolutely committed to implementation; we want to move forward,” said Dooley.

In October, California became the first state to pass legislation authorizing a health exchange. The five-person board that will govern the exchange already has three appointed members: Dooley, Belshe and Susan Kennedy, Schwarzenegger’s former chief of staff. The California Senate and Assembly are expected to appoint the remaining two members of the board in the next month. A search for an executive director will follow shortly afterward, as will a business plan, applications for grants and outreach to communities.

The pace in California doesn’t show any sign of letting up. The state will very likely continue to abide by what Belshe identifies as its guiding principle: “2014 is tomorrow.”

California should be anxious to implement the new plan. They have the most to gain. They should be careful not to get too far out front. They are spending money they don't have implementing a federal law that many want repealed.

Caleefornia just got rid of a governator that suffered from excessive steroid use and has replaced him with a retread from the pot farm. The State is 26 billion in the hole and can't afford to pay attention. They have one of the highest overall tax rates in the country. They are going to be the "Pace Car forObama healthcare" NEWS FLASH! The Pace Car is out of gas, the roads are falling apart, unemployment is over 12.5% and the only prosperity is with the public employees and politicians and they are going to do what???????????

More clueless hype from the leftwing media. Not one word about California's failed budget boardering on bankruptcy. California is fooling itself to think it is leading the country in anything other than bankruptcy.

It does seem that the posters here have it understood that. CA will fall over the cliff ,

CA looks blindly an asks the rest of America," HOW could this happen?"

The leadership with full duplicity in CA won't enforce all laws there, on all issues of illegal immigration that has destroyed their cities and CA's state of the union.

NO, CA the USA can't save you

. The Federal Gov't is broke and can't save you. The only people tha tcan save CA, is YOU.

Get over yourselves and start kicking out your illegal population. Send them home and off your entitlement welfare rolls , Your a nanny states becasue you refuse to enforce the rule of law.

Your elected leadership Nancy Pelosi , has done more damage to your state and turned it into a corrupted cesspool than any other leadership in America. Half the States in the USA have signed to sue over socialized medicine in America. A program that will Forced all of us to pay for medical care for thousands of people who are here for the fleecing of America. It hasn't worked in CA and it won't work for the rest of the country. Wake UP!

It does seem that the posters here have it understood that. CA will fall over the cliff ,

CA looks blindly an asks the rest of America," HOW could this happen?"

The leadership with full duplicity in CA won't enforce all laws there, on all issues of illegal immigration that has destroyed their cities and CA's state of the union.

NO, CA the USA can't save you

The Federal Gov't you its broke and can't save you. The only people that can save CA, is YOU.

Get over yourselves and start kicking out your illegal population. Send them home and off your entitlement welfare rolls. Your a nanny states becasue you refuse to enforce the rule of law.

Your elected leadership Nancy Pelosi , has done more damage to your state and turned it into a corrupted cesspool than any other leadership in America. Half the States in the USA have signed to sue over socialized medicine in America. A program that will Forced all of us to pay for medical care for thousands of people who are here for the fleecing of America. It hasn't worked in CA and it won't work for the rest of the country. Wake UP!

It does seem that the posters here have it understood that. CA will fall over the cliff ,

CA looks blindly an asks the rest of America," HOW could this happen?"

The leadership with full duplicity in CA won't enforce all laws there, on all issues of illegal immigration that has destroyed their cities and CA's state of the union.

NO, CA the USA can't save you

The Federal Gov't you its broke and can't save you. The only people that can save CA, is YOU.

Get over yourselves and start kicking out your illegal population. Send them home and off your entitlement welfare rolls. Your a nanny states becasue you refuse to enforce the rule of law.

Your elected leadership Nancy Pelosi , has done more damage to your state and turned it into a corrupted cesspool than any other leadership in America. Half the States in the USA have signed to sue over socialized medicine in America. A program that will Forced all of us to pay for medical care for thousands of people who are here for the fleecing of America. It hasn't worked in CA and it won't work for the rest of the country. Wake UP!

Jerry Brown must have been on one of his LSD trips with this other looney about "leading" on another massive spending spree. At what point does a State have any ill effects from bankruptcy? Obama is pleased because now he can watch a bankrupt state full of left wing looneys "lead" the US down the same path and feel good about himself. He is winning in his destruction of America as a free and proud country and with the California LSD'ers leading the way it probably sends a thrill up his leg or at least up Chris Matthews leg.

Come on folks. CALIFORNIA had a repub governer for 8 years. What else can you expect? Getting rid of teachers was dumb and the economy did not get any better. Ran this state deeper into the ground and very close to the cliff's edge. Same ole stuff as the good ole replub boys did at the WH with W, He learned from the best. So go on and let us have the same type of health care that the elected folks get and WILL receive for life. After all the rich fat cats can afford to pay for the very best health care but they still suck up the gov benefits from the little folk. If lifetime health care is taken away after they leave office, we would see a big change in health reform attitudes among the haters of the little and old folk. Meanwile. ENJOY being miserable and angry. Life goes on!!!!!